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[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5797 Engrossed in House (EH)]

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115th CONGRESS
  2d Session
                                H. R. 5797

_______________________________________________________________________

                                 AN ACT

 
   To amend title XIX of the Social Security Act to allow States to 
provide under Medicaid services for certain individuals with opioid use 
             disorders in institutions for mental diseases.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Individuals in Medicaid Deserve Care 
that is Appropriate and Responsible in its Execution Act'' or the ``IMD 
CARE Act''.

SEC. 2. MEDICAID STATE PLAN OPTION TO PROVIDE SERVICES FOR CERTAIN 
              INDIVIDUALS WITH TARGETED SUDS IN INSTITUTIONS FOR MENTAL 
              DISEASES.

    Section 1915 of the Social Security Act (42 U.S.C. 1396n) is 
amended by adding at the end the following new subsection:
    ``(l) State Plan Option To Provide Services for Certain Individuals 
in Institutions for Mental Diseases.--
            ``(1) In general.--With respect to calendar quarters 
        beginning during the period beginning January 1, 2019, and 
        ending December 31, 2023, a State may elect, through a State 
        plan amendment, to, notwithstanding section 1905(a), provide 
        medical assistance for services furnished in institutions for 
        mental diseases and for other medically necessary services 
        furnished to eligible individuals with targeted SUDs, in 
        accordance with the requirements of this subsection.
            ``(2) Payments.--
                    ``(A) In general.--Amounts expended under a State 
                plan amendment under paragraph (1) for services 
                described in such paragraph furnished, with respect to 
                a 12-month period, to an eligible individual with a 
                targeted SUD who is a patient in an institution for 
                mental diseases shall be treated as medical assistance 
                for which payment is made under section 1903(a) but 
                only to the extent that such services are furnished for 
                not more than a period of 30 days (whether or not 
                consecutive) during such 12-month period.
                    ``(B) Clarification.--Payment made under this 
                paragraph for expenditures under a State plan amendment 
                under this subsection with respect to services 
                described in paragraph (1) furnished to an eligible 
                individual with a targeted SUD shall not affect payment 
                that would otherwise be made under section 1903(a) for 
                expenditures under the State plan (or waiver of such 
                plan) for medical assistance for such individual.
            ``(3) Information required in state plan amendment.--
                    ``(A) In general.--A State electing to provide 
                medical assistance pursuant to this subsection shall 
                include with the submission of the State plan amendment 
                under paragraph (1) to the Secretary--
                            ``(i) a plan on how the State will improve 
                        access to outpatient care during the period of 
                        the State plan amendment, including a 
                        description of--
                                    ``(I) the process by which eligible 
                                individuals with targeted SUDs will 
                                make the transition from receiving 
                                inpatient services in an institution 
                                for mental diseases to appropriate 
                                outpatient care; and
                                    ``(II) the process the State will 
                                undertake to ensure eligible 
                                individuals with targeted SUDs are 
                                provided care in the most integrated 
                                setting appropriate to the needs of the 
                                individuals; and
                            ``(ii) a description of how the State plan 
                        amendment ensures an appropriate clinical 
                        screening of eligible individuals with targeted 
                        SUDs, including assessments to determine level 
                        of care and length of stay recommendations 
                        based upon the multidimensional assessment 
                        criteria of the American Society of Addiction 
                        Medicine and to determine the appropriate 
                        setting for such care.
                    ``(B) Report.--Not later than the sooner of 
                December 31, 2024, or 1 year after the date of the 
                termination of a State plan amendment under this 
                subsection, the State shall submit to the Secretary a 
                report that includes at least--
                            ``(i) the number of eligible individuals 
                        with targeted SUDs who received services 
                        pursuant to such State plan amendment;
                            ``(ii) the length of the stay of each such 
                        individual in an institution for mental 
                        diseases;
                            ``(iii) the type of outpatient treatment, 
                        including medication-assisted treatment, each 
                        such individual received after being discharged 
                        from such institution;
                            ``(iv) the number of eligible individuals 
                        with any co-occuring disorders who received 
                        services pursuant to such State plan amendment 
                        and the co-occuring disorders from which they 
                        suffer; and
                            ``(v) information regarding the effects of 
                        a State plan amendment on access to community 
                        care for individuals suffering from a mental 
                        disease other than substance use disorder.
            ``(4) Definitions.--In this subsection:
                    ``(A) Eligible individual with a targeted sud.--The 
                term `eligible individual with a targeted SUD' means an 
                individual who--
                            ``(i) with respect to a State, is enrolled 
                        for medical assistance under the State plan (or 
                        a waiver of such plan);
                            ``(ii) is at least 21 years of age;
                            ``(iii) has not attained 65 years of age; 
                        and
                            ``(iv) has been diagnosed with at least one 
                        targeted SUD.
                    ``(B) Institution for mental diseases.--The term 
                `institution for mental diseases' has the meaning given 
                such term in section 1905(i).
                    ``(C) Opioid prescription pain reliever.--The term 
                `opioid prescription pain reliever' includes 
                hydrocodone products, oxycodone products, tramadol 
                products, codeine products, morphine products, fentanyl 
                products, buprenorphine products, oxymorphone products, 
                meperidine products, hydromorphone products, methadone, 
                and any other prescription pain reliever identified by 
                the Assistant Secretary for Mental Health and Substance 
                Use.
                    ``(D) Other medically necessary services.--The term 
                `other medically necessary services' means, with 
                respect to an eligible individual with a targeted SUD 
                who is a patient in an institution for mental diseases, 
                items and services that are provided to such individual 
                outside of such institution to the extent that such 
                items and services would be treated as medical 
                assistance for such individual if such individual were 
                not a patient in such institution.
                    ``(E) Targeted sud.--
                            ``(i) In general.--The term `targeted SUD' 
                        means an opioid use disorder or a cocaine use 
                        disorder.
                            ``(ii) Cocaine use disorder.--The term 
                        `cocaine use disorder' means a disorder that 
                        meets the criteria of the Diagnostic and 
                        Statistical Manual of Mental Disorders, 4th 
                        Edition (or a successor edition), for either 
                        dependence or abuse for cocaine, including 
                        cocaine base (commonly referred to as `crack 
                        cocaine').
                            ``(iii) Opioid use disorder.--The term 
                        `opioid use disorder' means a disorder that 
                        meets the criteria of the Diagnostic and 
                        Statistical Manual of Mental Disorders, 4th 
                        Edition (or a successor edition), for heroin 
                        use disorder or pain reliever use disorder 
                        (including with respect to opioid prescription 
                        pain relievers).''.

SEC. 3. PROMOTING VALUE IN MEDICAID MANAGED CARE.

    Section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)) is 
amended by adding at the end the following new paragraph:
    ``(7)(A) With respect to expenditures described in subparagraph (B) 
that are incurred by a State for any fiscal year after fiscal year 2020 
(and before fiscal year 2024), in determining the pro rata share to 
which the United States is equitably entitled under subsection (d)(3), 
the Secretary shall substitute the Federal medical assistance 
percentage that applies for such fiscal year to the State under section 
1905(b) (without regard to any adjustments to such percentage 
applicable under such section or any other provision of law) for the 
percentage that applies to such expenditures under section 1905(y).
    ``(B) Expenditures described in this subparagraph, with respect to 
a fiscal year to which subparagraph (A) applies, are expenditures 
incurred by a State for payment for medical assistance provided to 
individuals described in subclause (VIII) of section 1902(a)(10)(A)(i) 
by a managed care entity, or other specified entity (as defined in 
subparagraph (D)(iii)), that are treated as remittances because the 
State--
            ``(i) has satisfied the requirement of section 438.8 of 
        title 42, Code of Federal Regulations (or any successor 
        regulation), by electing--
                    ``(I) in the case of a State described in 
                subparagraph (C), to apply a minimum medical loss ratio 
                (as defined in subparagraph (D)(ii)) that is at least 
                85 percent but not greater than the minimum medical 
                loss ratio (as so defined) that such State applied as 
                of May 31, 2018; or
                    ``(II) in the case of a State not described in 
                subparagraph (C), to apply a minimum medical loss ratio 
                that is equal to 85 percent; and
            ``(ii) recovered all or a portion of the expenditures as a 
        result of the entity's failure to meet such ratio.
    ``(C) For purposes of subparagraph (B), a State described in this 
subparagraph is a State that as of May 31, 2018, applied a minimum 
medical loss ratio (as calculated under subsection (d) of section 438.8 
of title 42, Code of Federal Regulations (as in effect on June 1, 
2018)) for payment for services provided by entities described in such 
subparagraph under the State plan under this title (or a waiver of the 
plan) that is equal to or greater than 85 percent.
    ``(D) For purposes of this paragraph:
            ``(i) The term `managed care entity' means a medicaid 
        managed care organization described in section 
        1932(a)(1)(B)(i).
            ``(ii) The term `minimum medical loss ratio' means, with 
        respect to a State, a minimum medical loss ratio (as calculated 
        under subsection (d) of section 438.8 of title 42, Code of 
        Federal Regulations (as in effect on June 1, 2018)) for payment 
        for services provided by entities described in subparagraph (B) 
        under the State plan under this title (or a waiver of the 
        plan).
            ``(iii) The term `other specified entity' means--
                    ``(I) a prepaid inpatient health plan, as defined 
                in section 438.2 of title 42, Code of Federal 
                Regulations (or any successor regulation); and
                    ``(II) a prepaid ambulatory health plan, as defined 
                in such section (or any successor regulation).''.

            Passed the House of Representatives June 20, 2018.

            Attest:

                                                                 Clerk.
115th CONGRESS

  2d Session

                               H. R. 5797

_______________________________________________________________________

                                 AN ACT

   To amend title XIX of the Social Security Act to allow States to 
provide under Medicaid services for certain individuals with opioid use 
             disorders in institutions for mental diseases.
```